Contemporary Pediatrics® Editorial Advisory Board member Andrew Schuman, MD, clinical assistant professor of pediatrics, Geisel School of Medicine, Dartmouth, discusses whether infant sleep systems are needed for a safe sleeping environment.
Hi, and welcome back to Contemporary Pediatrics®. I'm editor Joshua Fitch.
Andrew Schuman, MD:
And I'm Andy Schuman. I'm a pediatrician in New Hampshire. I am on the Editorial Board of Contemporary Pediatrics®. I am the editor of the Practice Improvement section of that publication. I'm also clinical assistant professor of pediatrics at the Geisel School of Medicine at Dartmouth. Nice to see you Josh.
Nice to see you Dr. Schuman, thank you so much for taking the time to speak with us. Today we're discussing the recent FDA marketing authorization for Happiest Baby Incorporated, SNOO Smart Sleeper, an over the counter infant sleep system. According to the FDA, the bassinet and sleep sack system is intended to keep infants up to six months old that can't rollover consistently on their back. First Dr. Schuman, according to the National Institute of Child Health and Human Development, infants in the supine sleep position are at a lower risk for sudden infant death syndrome and sudden unexpected infant death. What is the benefit of a device like this and what is advised when parents inquire about this type of technology?
As you know, Josh, I've been writing about technology in regards to pediatric practice for for decades, and I tend to be very conservative, particularly when it comes to technologies that I recommend for parents. So there's a lot of confusion in the marketplace these days regarding recommendations, particularly from the FDA or news briefs, and so forth. So it's important that parents understand what a new device is intended to do, what it's capable of doing, and what it doesn't do. And as a pediatrician, I am firmly a believer in recommendations that have been developed by the American Academy of Pediatrics. And if I could talk a little bit about the updated guidelines that were published last year by the AAP, they came out with new recommendations regarding sleep in young infants. And some of them have continued the previous recommendations and some representative the a departure from previous recommendations. So as you mentioned, that starting in the 90s, we began to recommend the supine position and there was a radical improvement in the situation with SIDS. In other words, the supine position has radically lowered the incidence of SIDS in the pediatric population. It's interesting because our understanding has increased quite a bit. So SIDS, sudden infant deaths is a subset of Sudden Unexplained Infant Deaths. And we now know that there are many abnormal abnormalities that can predispose to an infant to sudden death, which is not SIDS. There are metabolic conditions, cardiac conditions, I had a conversation this morning, with our geneticist and the newborn screening identified a child with a metabolic abnormality which is associated with Sudden Unexplained Infant Deaths. So long story short, I think through your questions, we'll go over the particulars of the new recommendations. So I take FDA recommendations regarding things like sleep systems and home technology to render a baby sleep with somewhat of a grain of salt. And we'll talk a little bit more and I'll go into the particulars of the recommendations that were changed last year.
Sure, thank you very much. Are there any trends in light of that, that you know, of when it comes to parents that use sleep systems or this type of technology for their infants, any existing associations with the technology already?
In general, I encountered very few parents in my practice where the baby has sleep problems, particularly in the first few months of life, babies excel at sleeping, more so than editors more so than pediatricians, and so it's not a big problem. Grandparents, like myself, however, love to buy things for new parents, so they want the latest and greatest and often the most expensive, and that's not always the best. I caution people about something that has not been in the market for a long period of time, I have been aware of many products recommended for sleep to assist with sleep baby positioning that have been recalled because they've been associated with infants deaths, there are some models of infant sleepers. I think Fisher Price had one... It doesn't take many lawsuits or, you know, unexpected infant deaths to have a product recalled. So, first and foremost, I advise caution, and usually, sophisticated systems are not at all necessary to help with infant sleep. So we should probably at least mentioned that parents should encourage or we should encourage parents to provide a safe sleep environment for the kids. Babies will roll usually by four to seven months of age on to their stomach with this is not a bad thing. And we should not discourage babies from rolling if they roll on their stomach, we should not turn them over again. So it's recommended that you place your baby in a crib. Okay, that meets the safety standards of the Consumer Product Safety Commission, which is the CPSC and they've got a website cpsc.gov. You should check the CPSC for recalls, make sure the mattress is appropriately designed for your crib and fits tightly, don't use a crib that doesn't have instructions, and alternative sleep services are only to be considered as a safe option if they comply with the recommendations of the CPSC. If a baby falls asleep in a car seat, you should move them to affirm sleep surface on their back as soon as possible. Breastfeeding and using a pacifier also helps in decreasing the incidence of SIDS, and that should be also considered as well. You shouldn't sleep with your baby, because that is sometimes associated with parents rolling over on the baby and suffocating them. Avoid soft objects, crib bumpers, loose bedding and keep them out of the baby's sleep area. So these are the important things that pediatricians should recommend to parents to assure that the baby is in a safe sleep environment.
And it sounds Dr. Schuman, by and large, this is something that parents can do directly with essentially what they have it sounds like is that accurate?
Absolutely. So they don't need to spend a lot of money. And some of these systems sold by the Happiest Baby are in excess of $1,500. So you might put that towards a wedding or college or gasoline money for travel or something like that. I'm not disparaging, you know this product, but I don't know enough about it to fully recommend it. And I know one has to be very cautious when one makes a recommendation. There are a lot of products that are promoted, I'm sure in parenting magazines. You know, some people use something called I think it's an owl system, O-W-L, which has as part of the system of pulse oximeter and parents should not believe that having a pulse oximeter will prevent the baby from having SIDS. A lot of parents obviously are concerned about SIDS, the best thing you could do is follow the advice available from the AAP website healthychildren.org and they go over the safe sleeping recommendations that I just mentioned. Simpler is better, and the incidence of SIDS is extremely low and other than a safe sleeping environment using a pacifier and nursing your baby, these are other things that pediatricians generally recommend to parents.